The dedicated eye care professionals at Bennett & Bloom Eye Centers are committed to providing patients who suffer with glaucoma the knowledge and care you need to preserve your vision and maintain your eye health. We offer personalized glaucoma management with a variety of treatment options, including glaucoma surgery, in Louisville.
Glaucoma is commonly referred to as “the silent thief of sight,” because in most cases it progresses gradually and quietly. Vision can be damaged without any noticeable symptoms. It may begin with loss of peripheral vision and then progress to central vision loss and blindness. It affects nearly two out of every 100 people over the age of 35. Half of those are at risk for blindness because they may not even know they have the disease.
Glaucoma is a complex disease associated with the build-up of fluid pressure inside the eye that can damage the optic nerve. The optic nerve, a bundle of over a million nerve fibers, transmits the message of sight from the eye to the brain. In glaucoma, the nerve fibers carrying peripheral vision are affected first. This reduction in side vision can be gradual and is usually asymptomatic. By the time it affects central or reading vision, tremendous damage to the nerve has already occurred.
At Bennett & Bloom Eye Centers, our doctors use the most up-to-date technology to diagnose and treat glaucoma. With early detection and careful management, significant damage to eyesight from glaucoma is nearly always preventable, although treatment cannot restore vision that has already been lost.
To understand what’s happening with glaucoma, imagine the eye as a sink with water. The clear fluid inside the eye (aqueous humor, produced by the ciliary body) and is always flowing into and out of the eye, just like a sink with an open faucet and drain. As long as the drain is open, a sink won’t overflow. But if anything happens to block the drain, the water level rises and spills over the edge. Since the eye is a closed ball, blockage to its drain (the trabecular meshwork) and pipe (Schlemm’s canal) doesn’t cause aqueous to overflow or leak out. It has nowhere to overflow. Rather, the eye’s fluid pressure increases and damages the optic nerve.
Primary open-angle glaucoma (POAG) is, by far, the most common type and affects more than three million Americans and almost 60 million people worldwide. In this type of glaucoma, the eye’s drainage system, known as the trabecular meshwork, does not function correctly. This results in a gradual increase in intraocular pressure over time, which can damage the optic nerve and lead to vision loss. When we mention glaucoma without specifying a type, you can assume we are discussing open-angle glaucoma.
The other major type of glaucoma is narrow (closed) angle glaucoma. With narrow angles the iris (the colored part of the eye) blocks the trabecular meshwork’s opening, causing a sudden severe rise in eye pressure. This can cause halos around lights, severe pain, and rapid vision loss.
Both of these types of glaucoma can be inherited. If someone in your family has glaucoma, your risk of developing it is increased. Likewise, if you have glaucoma, others in your family need to be made aware that their risk is increased. There are numerous other types of glaucoma, including secondary, juvenile, pseudoexfoliation syndrome, and pigment dispersion syndrome.
At Bennett & Bloom Eye Centers, our doctors use the very latest technology to identify patients with glaucoma. The diagnosis is not always clear-cut since each eye varies in its susceptibility to eye pressure.Successful diagnosis and treatment begin with a careful ocular evaluation.
In most cases, open-angle glaucoma can be treated with eye drops taken once or twice daily. These drops help lower eye pressure and reduce the risk of further vision loss. Sometimes more than one drop is needed. If drops do not adequately control eye pressure, laser or surgery may be needed. There are many types of glaucoma drops:
Reduces the production of fluid in the eye. Drugs include Alphagan P (brimonidine tartrate) and Iopidine (apraclonidine hydrochloride).
Reduces the production of fluid in the eye. Drugs include Betimol (timolol), Timoptic XE (timolol maleate), and Betoptic S (betaxolol hydrochloride).
Improves the outflow of fluid. Drugs include Travatan (travoprost), Lumigan (bimatoprost) and Xalatan (latanoprost).
Reduces the production of fluid in the eye. Drugs include Trusopt (dorzolamide) and Azopt (brinzolamide)
Drugs include Rhopressa (netarusdil) [increases the outflow of fluid (increased trabecular meshwork outflow, reduces episcleral venous pressure) and decreases aqueous production (inhibits norepinephrine)] and Vyzulta (latanoprostene bunod) [increases the outflow of fluid thru the trabecular meshwork and uveoscleral routes].
Some of the above drops are combined together to lower eye pressure. Drugs include Combigan (brimonidine and timolol), Cosopt (dorzolamide and timolol), Simbrinza (brimonidine and brinzolamide) and Rocklatan (netarsudil and latanoprost).
Improves the outflow of fluid from the eye.
SLT is a safe, painless, 5-minute office procedure that uses the Lumenis Selecta II laser to lower eye pressure and reduce the need for eye drops. It uses an extremely short burst of laser energy to selectively treat and remove pigmented cells that may clog the trabecular meshwork. Compared to traditional argon laser trabeculoplasty, SLT does not cause any structural changes or scarring so it can be repeated as needed. Patients who are not controlled by eye drops, who cannot afford eye drops, or who have poor compliance with eye drops are good candidates for SLT.
This state of the art procedure utilizes a laser to lower pressure by treating the ciliary body (the part of the eye that produces aqueous humor). Eye pressure is lowered by decreasing the production of aqueous entering the eye. ECP is usually performed at the time of cataract surgery. After this procedure, 95% of patients achieve a lower eye pressure on fewer or the same number of eye drops.
CPC, an outpatient procedure performed with the Iridex CYCLO G6 Glaucoma Laser System. It is similar to ECP in that it lowers eye pressure by treating the ciliary body and decreasing aqueous production. Unlike ECP, CPC is used externally and is not done in conjunction with other surgery. Most patients experience a significant decrease in pressure and eye pain after the procedure which has little post-operative recovery.
The iStent represents the first FDA approved MIGS or micro-invasive glaucoma surgery. It works by allowing a direct communication between the inside of the eye and Schlemm’s canal. Eye pressure often decreases and reduces or eliminates the need for glaucoma drops.
This tiny device is placed within the trabecular meshwork during cataract surgery. After the surgeon has removed the cataract and replaced it with an intraocular lens, a specially designed mirror enables the surgeon to carefully and gently place the stent into its correct position. Inserting the iStent adds little time to the cataract procedure, and does not require any additional post-operative recovery or risk of complications. Because the iStent is the smallest medical device available, patients are unable to see it after it has been implanted.
The iStent is an excellent option for patients with mild to moderate open angle glaucoma who are interested in having cataract surgery. Because the iStent is covered by Medicare and most private insurance companies, most patients do not have any additional out of pocket expense.
The Kahook Dual Blade is a minimally invasive procedure done at the time of cataract surgery for patients with mild to severe open-angle glaucoma. Utilizing 2 small precision engineered blades, approximately one-quarter to one-third of the trabecular meshwork is removed. This adds little time to the cataract procedure and does not require any additional post-operative recovery or significant risk of complications. By allowing the fluid within the eye to flow uninterrupted into Schlemm’s canal, eye pressure is lowered with less dependence on glaucoma drops.
The XEN Gel stent is one of the most recent advancements in glaucoma care and Bennett & Bloom is excited to be among the first in Kentucky to offer this technology to their patients. It is indicated for glaucoma that is either not responding or progressing despite drops. This tiny 6 mm device, about the width of a human hair, is inserted through a small corneal incision combined with regular cataract surgery or as a standalone procedure. The stent becomes soft and flexible providing long term decreased eye pressure. However, some patients may still require further eye drops to help control the pressure.
This small flexible stent is roughly the size of a human eyelash and constructed of a nickel-titanium alloy. Like other minimally invasive surgeries, it is performed at the time of uncomplicated cataract surgery with minimal postoperative complications. The Hydrus microstent dilates or expands Schlemm’s canal, the eye’s natural drainage channel. The helps lower eye pressure and reduce the dependence on eye drops.
This biodegradable bimatoprost implant is compromised of the same active ingredient found in Lumigan, one of the most popular glaucoma drops. Durysta is painlessly inserted into the front part of the eye through a small injection in the office. It works similarly to Lumigan drops in that it enhances the eye’s natural drainage pathway to decrease intraocular pressure. Over 30% of eyes remain well controlled after 1 year and 25% at 2 years. Current FDA approval limits the eye to only a single injection.
Glaucoma surgeries are used as a last resort for patients not controlled with drops or laser. Postoperatively, patients are on strict activity restrictions for about a month and may have to miss work while the eye heals. Most have good eye pressure with minimal or no eye drops. However, glaucoma is not cured with surgery. Eye drops may need to be restarted and some may even require more surgery. It is very difficult to predict exactly how long a glaucoma surgery will last, with some working for over 10 years and others failing in under a year. The eye pressure still needs to be checked regularly. Surgery involves risks that less invasive lasers and procedures do not. Although rare, these risks can harm one’s vision. Rarely, the surgical site can develop a vision or eye threatening infection. If a glaucoma surgery patient ever develops a red, blurry, or painful eye, whether following recent surgery or many years later, they need to be examined right away to rule out infection.
Trabeculectomy surgery lowers eye pressure by allowing aqueous humor to directly flow out of the eye through a surgically created scleral incision. This procedure may be done alone, or in combination with cataract surgery if a visually significant cataract is present.
These procedures lower eye pressure by allowing aqueous humor to flow directly out of the eye. Current implants include non-valved (Baerveldt, Molteno) and valved (Ahmed) devices. Drainage devices are less likely to get infections than Ex-PRESS™ or trabeculectomy surgeries. Drainage devices carry a very low risk of double vision that is typically treated with a change in glasses prescription.
In most cases, narrow-angle glaucoma is treated by YAG laser iridotomy. The laser is used to create a painless opening in the iris (colored part of the eye) for fluid drainage. This may be preventative or may be performed in an emergency setting to prevent permanent vision loss and may need to be repeated depending on the iris color. Risks of bleeding, inflammation and a temporary increase in eye pressure are small. There are no postoperative restrictions. Your eye doctor typically prescribes an anti-inflammatory eye drop for a few days to help limit any post-laser irritation. In some instances, your doctor may recommend cataract surgery instead of a YAG laser iridotomy. Because artificial lenses are much thinner than the natural cataract lens, such replacement reduces the crowding that causes narrow angles in the first place. During cataract removal, the surgeon can sometimes break any scarring around the trabecular meshwork (goniosynechialysis) to improve its function and reduce dependence on pressure drops.
Virtually no one should be blinded from glaucoma. Treatments are highly effective and, while vision already lost cannot be restored, the significant further loss can be avoided. The most important ingredient in successful glaucoma management is patient compliance. Continuous pressure control is possible only by strictly following your treatment plan…and that is primarily up to you. In most cases, the only people who become blind from glaucoma are those who do so before their condition is diagnosed or who do not follow their doctor’s advice and treatment regimen.
